Cognitive Factors Influencing COVID-19 Vaccination Intentions: An Application of the Protection Motivation Theory Using a Probability Community Sample

Abstract

COVID-19 vaccines have been shown to provide protection against severe disease and death. However, substantial individual differences in vaccination intentions have hindered achieving optimal vaccination rates across the population. To look for efficient strategies to promote vaccination, this study tested whether the protection motivation theory (PMT), a cognitive model based upon threat and coping appraisals, would account for the differences in vaccination intentions under three scenarios (i.e., in the context of getting vaccinated in general, and in the context of high- and low- efficacy for reducing COVID-19 transmission risk). A phone survey was conducted in early 2021 and obtained a probability community sample (n = 472; 49.2% men) in Macao, China. We found that 54.0% of respondents indicated their relatively strong intention to receive COVID-19 vaccination for high-efficacy vaccines, compared to 29.5% for low-efficacy vaccines and 31.0% for vaccines in general. After adjusting for demographics, self-efficacy (i.e., the perceived capability of receiving COVID-19 vaccines) and maladaptive response reward (i.e., the perceived benefits of not receiving COVID-19 vaccines) were consistently associated with COVID-19 vaccination intentions under all three scenarios. The perceived severity of COVID-19 infection and response cost (i.e., the perceived costs of receiving COVID-19 vaccines) were significantly associated with vaccination intention for high-efficacy vaccines, while the response efficacy of lowering the COVID-19 impact with COVID-19 vaccination was positively associated with vaccination intention for general and low-efficacy vaccines. Given that the relative strength of PMT constructs depends on perceived vaccine efficacy, we recommend taking PMT constructs and vaccine efficacy into account for encouraging vaccination.